Social Worker Data Entry

Nina Kurup

404-***-**** **********@*****.*** Atlanta, GA 30317

SUMMARY

Highly motivated employee with desire to take on new challenges. Strong work ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

SKILLS

Referral Coordination

Patient support

Utilization review

Regulatory Compliance

Client Advocacy

Case Management

Health History Documentation

Documentation proficiency

Organization and Multitasking

Interdisciplinary Collaboration

EXPERIENCE

Case Manager/Social Worker, Dekalb Medical/Emory Decatur, November 2003- December 2024

Decatur, GA

Exercise versatility in fast-paced, agile work environments.

Participated in ongoing training and compliance activities.

Conducted pre-certification process for medical procedures and services to ensure compliance with insurance requirements.

Analyzed patient information, benefit coverage details, and other pertinent data to determine eligibility for benefits.

Reviewed claims denials from insurance companies and worked with providers to resolve issues in a timely manner.

Assisted providers in obtaining prior authorization approvals by submitting paperwork via fax or electronically.

Maintained accurate records of all pre-certification activities in accordance with established guidelines.

Served as a liaison between providers, patients, and third-party payers.

Analyzed treatment plans for appropriateness, effectiveness and medical necessity in accordance with established criteria.

Conducted concurrent reviews to monitor the ongoing appropriateness of services provided to members.

Collaborated with physicians, nurses, case managers, discharge planners, social workers and other healthcare professionals to develop a comprehensive plan of care within specified guidelines.

Interpreted coverage policies and benefit provisions as they relate to the clinical setting.

Provided psychosocial assessments to patients and their families.

Coordinated discharge planning services, including arranging transportation and home care assistance after hospitalization.

Maintained detailed records regarding patient progress, clinical interventions and case notes in accordance with HIPAA regulations.

Participated in interdisciplinary team meetings to discuss patient needs and plan appropriate interventions.

Coordinated psychosocial assessments, treatment plans and progress notes.

Maintained confidential case documentation.

EDUCATION AND TRAINING

Master of Science

Social Work, Columbia University in The City of New York, New York NY May 1992

Bachelor of Arts

Psychology And Spanish, Emory University, Atlanta GA May 1989

CERTIFICATIONS

LMSW

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